August 05, 2014

Ebola: Why no ZMapp for Africans?

As the second U.S. Ebola patient arrived in Atlanta on Tuesday, health authorities in Liberia raised questions about how the woman and an American doctor were given an experimental U.S. treatment unavailable to the hundreds of Africans sickened by the deadly virus.

While still in Liberia, both Nancy Writebol, who was working at an Ebola center for a Christian charity, and Kent Brantly, a physician there, received an experimental drug known as ZMapp. The drug's safety hasn't been tested in humans, and experts said it is too soon to know if it is effective.

For the drug to be used in Liberia, it would have to be approved by the country's Ministry of Health Ethical Committee, said Bernice Dahn, Liberia's chief medical officer.

Dr. Dahn said she wasn't aware of the committee approving any experimental Ebola treatment, though she also wasn't aware of any being disapproved. It is conceivable a treatment was approved without her knowledge, she said. Liberia's assistant health minister, Tolbert Nyenswah, didn't know of any approval. Liberia's presidency also wasn't aware, said Information Minister Lewis Brown.

Now, Dr. Nyenswah said, officials have been beset with requests from dying patients and their relatives for the same treatment.

"This is something that has made our job most difficult," Dr. Nyenswah said. "The population here is asking: 'You said there was no cure for Ebola, but the Americans are curing it?'"

Liberian officials were set to meet Wednesday with the World Health Organization to see about getting the experimental drug rushed into use for other patients, said Dr. Nyenswah.

Ebola, which is usually fatal, causes fever, headaches, vomiting and diarrhea and can cause internal bleeding. The virus is transmitted through bodily fluids. The Ebola outbreak, the largest in history, started in February and has spread through Liberia, Guinea and Sierra Leone.

Details of how ZMapp was administered to the patients in Liberia—and who authorized its use—remained sketchy Tuesday.

Bruce Johnson, president of SIM USA, the Charlotte, N.C.-based charity with which Ms. Writebol, 59, and her husband, David, went to Africa, said at a news conference Tuesday that the decision to use the drug was left to the patients, their families and their doctors.

Very difficult for everyone: If ZMapp had been administered to African cases, and any of them had died, the US would have been condemned as using humans as guinea pigs. As it is, the American cases may not survive—or if they do, it may be due to better care in more sterile surroundings rather than to the drug.

But if the Liberian minister of health was kept out of the loop about the decision to administer ZMapp, it begins to look like old-fashioned extraterritoriality: Never mind what the locals say, we run on our own rules.

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As the second U.S. Ebola patient arrived in Atlanta on Tuesday, health authorities in Liberia raised questions about how the woman and an American doctor were given an experimental U.S. treatment unavailable to the hundreds of Africans sickened by the deadly virus.

While still in Liberia, both Nancy Writebol, who was working at an Ebola center for a Christian charity, and Kent Brantly, a physician there, received an experimental drug known as ZMapp. The drug's safety hasn't been tested in humans, and experts said it is too soon to know if it is effective.

For the drug to be used in Liberia, it would have to be approved by the country's Ministry of Health Ethical Committee, said Bernice Dahn, Liberia's chief medical officer.

Dr. Dahn said she wasn't aware of the committee approving any experimental Ebola treatment, though she also wasn't aware of any being disapproved. It is conceivable a treatment was approved without her knowledge, she said. Liberia's assistant health minister, Tolbert Nyenswah, didn't know of any approval. Liberia's presidency also wasn't aware, said Information Minister Lewis Brown.

Now, Dr. Nyenswah said, officials have been beset with requests from dying patients and their relatives for the same treatment.

"This is something that has made our job most difficult," Dr. Nyenswah said. "The population here is asking: 'You said there was no cure for Ebola, but the Americans are curing it?'"

Liberian officials were set to meet Wednesday with the World Health Organization to see about getting the experimental drug rushed into use for other patients, said Dr. Nyenswah.

Ebola, which is usually fatal, causes fever, headaches, vomiting and diarrhea and can cause internal bleeding. The virus is transmitted through bodily fluids. The Ebola outbreak, the largest in history, started in February and has spread through Liberia, Guinea and Sierra Leone.

Details of how ZMapp was administered to the patients in Liberia—and who authorized its use—remained sketchy Tuesday.

Bruce Johnson, president of SIM USA, the Charlotte, N.C.-based charity with which Ms. Writebol, 59, and her husband, David, went to Africa, said at a news conference Tuesday that the decision to use the drug was left to the patients, their families and their doctors.

Very difficult for everyone: If ZMapp had been administered to African cases, and any of them had died, the US would have been condemned as using humans as guinea pigs. As it is, the American cases may not survive—or if they do, it may be due to better care in more sterile surroundings rather than to the drug.

But if the Liberian minister of health was kept out of the loop about the decision to administer ZMapp, it begins to look like old-fashioned extraterritoriality: Never mind what the locals say, we run on our own rules.